Stupp protocol

Last revised by Arlene Campos on 6 Nov 2024

The Stupp protocol has become the standard of care for the treatment of high-grade astrocytoma and glioblastoma since its publication in 2005 and has led to significant survival improvements 1. It consists of radiation therapy and concomitant chemotherapy with temozolomide, an alkylating agent.

According to the original study, the Stupp protocol comprises: 

  • radiation therapy

    • total 60 Gy

    • 2 Gy per daily fraction (Monday to Friday) over 6 weeks

  • temozolomide

    • during radiation therapy: 75 mg per square meter of body-surface area per day, 7 days per week

    • post-radiation therapy (adjuvant): 6 cycles consisting of 150-200 mg per square meter for 5 days during each 28-day cycle

This therapy resulted in a significant survival improvement at 2 years: 

  • 26.5% 2-year-survival with Stupp protocol

  • 10.4% 2-year-survival with radiation therapy alone

A substantial minority of patients can demonstrate changes of pseudoprogression on follow-up imaging. 

The Stupp protocol is named after Roger Stupp the first author of the 2005 paper, who is a Swiss oncologist working out of Northwestern University School of Medicine, previously the University of Zürich 1

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